Medicaid Management Information System

MMIS is the largest health care payment system in Minnesota, and one of the largest payment systems in the nation. Health care providers throughout the county – as well as DHS and county staff – use MMIS to pay the medical bills and managed care payments for over 525,000 Minnesotans enrolled in MinnesotaCare, Medical Assistance (MA), General Assistance Medical Care (GAMC) and the Alternative Care Grants Program (ACG). These public programs (collectively referred to as the Minnesota Health Care Programs, or MHCP) provide health care services to low-income families and children, low-income elderly people and individuals who have physical and/or developmental disabilities, mental illness or who are chronically ill.

Some MHCP enrollees receive care through a fee-for-service arrangement where they find their own doctor. Others receive care through one of 9 state-contracted managed care health plans.

MMIS II began operating in 1994, replacing MMIS I that had been in use since 1974.

MMIS is state-owned and operated and has 15 subsystems, more than five years of online provider billing history, and over 500 screens and 900 claim edits to ensure appropriate payment.

MMIS processes 99 percent of all "clean" claims within 30 days of receipt, with the average claim processed within two to three days. 96 percent of all MMIS transactions are made using electronic data interchange (EDI). MMIS encourages providers to submit bills electronically, since paper-based billing costs the state more money.

Recent System Highlights

• HCO sent the 2001 MMIS Provider Satisfaction Survey to MHCP providers. (Past surveys confirm that over 96% of respondents were pleased with MMIS.)

• HCO developed a Provider Report Card to target providers submitting over 50% of their claims with significant errors. The Report Card suggested billing corrections that would increase the speed of reimbursements for health care claims.

• DHS received a federal grant to develop a national model for a payment accuracy measurement system.

• HCO established a county data unit share DHS Data Warehouse information and reporting capabilities with county staff.

• HCO recruited and developed existing DHS staff with health care expertise to become MMIS system programmers.